[Comorbidity and cardiovascular risk in subjects with initial diagnosis of hypercholesterolemia]. / Comorbilidad y riesgo cardiovascular en sujetos con primer diagnóstico de hipercolesterolemia.

BACKGROUND: For a proper approach to the subjects, in which the presence of hypercholesterolemia is identified for the first time, is important to consider simultaneously both cardiovascular risk factors and the presence of other diseases. The purpose of our study was to describe the lipid profile of patients in which the presence of hypercholesterolemia is detected for the frist time and to determine their cardiovascular risk and comorbidity. METHODS: Observational cross-sectional study in a Primary Care setting. In 274 subjects with a plasma cholesterol level higher or equal to 200 mg / dL ("limit" hypercholesterolemia), selected by consecutive sampling, we assessed: lipid profile, cardiovascular risk factors and cardiovascular risk (SCORE and Castelli's atherogenic index), comorbidity (Charlson's Index) and sociodemographic characteristics. RESULTS: The mean cholesterol level was 232.9 mg/dl. Hypercholesterolaemia was reported "definite" (>= 250 mg / dl) in 21.1% (95% CI: 16.2 to 26.1). A 9.5% showed a cardiovascular risk >= 5%. Lipoprotein ratio of total cholesterol/HDL cholesterol was higher in men than in women (4.4 vs. 3.8, p <0.001) in subjects with Charlson's Comorbidity Index > = 1 (4.1 vs. 3.9, p = 0.04), in smokers (4.3 vs. 3.9, p = 0.04) and in hypertensive subjects (4.2 vs. 3.9, p = 0.03), obese (4.2 vs 3 , 7, p <0.05) or with the metabolic syndrome (4.4 vs 3.9, p = 0.02). We observed a higher proportion of subjects with moderate cardiovascular risk / high or cardiovascular disease in those with comorbidity (87.3% vs 42.3%, p <0.01). CONCLUSIONS: More than a third of the subjects in which "limit" cholesterol was identifiyed for the first time presents comorbidity, being "defined" hypercholesterolemia in 21.1% of the cases. Takeing in consideration the Score function assessment, one outif 10 subjects presents high cardiovascular mortality risk after 10 years. Both lipoprotein ratio and cardiovascular risk are markedly higher in subjects with comorbidity.

Comorbilidad y riesgo cardiovascular en sujetos con primer diagnóstico de hipercolesterolemia / Comorbidity and cardiovascular risk in subjects with initial diagnosis of hypercholesterolemia

Fundamento: Para un adecuado abordaje de los sujetos en los que se identifica por primera vez la presencia de hipercolesterolemia es importante considerar simultáneamente tanto sus factores de riesgo cardiovascular como la presencia de otras enfermedades. El objetivo de nuestro estudio es describir el perfil lipídico de los sujetos en los que por primera vez se detecta hipercolesterolemia y determinar su riesgo cardiovascular y comorbilidad. Métodos: Estudio observacional transversal realizado en 274 sujetos en los que se identificó un nivel de colesterol plasmático >200 mg/dl (hipercolesterolemia “límite”), seleccionados mediante muestreo consecutivo. Se evaluó perfil lipídico, factores de riesgo cardiovascular y riesgo cardiovascular (SCORE e índice aterógénico de Castelli), comorbilidad(Índice de Charlson) y características sociodemográficas. Resultados: El nivel medio de colesterol fue de 232,9 mg/dl. Se observó hipercolesterolemia “definida” (> 250 mg/dl) en el 21,1% (IC95%: 16,2-26,1). El 9,5% mostró un riesgo cardiovascular > 5%. El cociente lipoprotéico colesterol total/colesterol HDL fue superior en hombres queen mujeres (4,4 vs 3,8 (p<0,001), en sujetos con Índice de Comorbilidad de Charlson > 1 (4,1 vs 3,9 p=0,04), en fumadores (4,3 vs 3,9 (p=0,04) y en sujetos hipertensos (4,2 vs 3,9,(p=0,03), obesos (4,2 vs 3,7 ( p<0,05) o con síndrome metabólico (4,4 vs 3,9 ( p=0,02). Se observó mayor proporción de sujetos con riesgo cardiovascular moderado/alto o enfermedad cardiovascular entre los que presentaban comorbilidad (87,3% vs 42,3% (p<0,01). Conclusiones: Más de la tercera parte de los sujetos en los que se identifica por primera vez hipercolesterolemia “límite” presenta comorbilidad, tratándose de hipercolesterolemia “definida” en el 21,1%. Considerando la función Score, uno de cada 10 pacientes presenta riesgo elevado de mortalidad cardiovascular después de 10 años. Tanto el cociente lipoprotéico como el cardiovascular son claramente superiores en sujetos que presentan comorbilidad(AU)

Background: For a proper approach to the subjects, in which the presence of hypercholesterolemia is identified for the first time, is important to consider simultaneously both cardiovascular risk factors and the presence of other diseases. The purpose of our study was to describe the lipid profile of patients in which the presence of hypercholesterolemia is detected for the frist time and to determine their cardiovascular risk and comorbidity. Methods: Observational cross-sectional study in a Primary Care setting. In 274 subjects with a plasma cholesterol level higher or equal to 200 mg / dL ("limit" hypercholesterolemia), selected by consecutive sampling, we assessed: lipid profile, cardiovascular risk factors and cardiovascular risk (SCORE and Castelli's atherogenic index), comorbidity (Charlson's Index) and sociodemographic characteristics. Results:The mean cholesterol level was 232.9 mg/dl. Hypercholesterolaemia was reported "definite" (> = 250 mg / dl) in 21.1% (95% CI: 16.2 to 26.1). A 9.5% showed a cardiovascular risk > = 5%. Lipoprotein ratio of total cholesterol/HDL cholesterol was higher in men than in women (4.4 vs. 3.8, p <0.001) in subjects with Charlson's Comorbidity Index > = 1 (4.1 vs. 3.9, p = 0.04), in smokers (4.3 vs. 3.9, p = 0.04) and in hypertensive subjects (4.2 vs. 3.9, p = 0.03), obese (4.2 vs 3 , 7, p <0.05) or with the metabolic syndrome (4.4 vs 3.9, p = 0.02). We observed a higher proportion of subjects with moderate cardiovascular risk / high or cardiovascular disease in those with comorbidity (87.3% vs 42.3%, p <0.01). Conclusions: More than a third of the subjects in which "limit" cholesterol was identifiyed for the first time presents comorbidity, being "defined" hypercholesterolemia in 21.1% of the cases. Takeing in consideration the Score function assessment, one outif 10 subjects presents high cardiovascular mortality risk after 10 years. Both lipoprotein ratio and cardiovascular risk are markedly higher in subjects with comorbidity(AU)

La integración de la gestión de la Atención Primaria de Salud y la Atención Hospitalaria / No disponible

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Calidad de la prescripción en Atención Primaria: ¿a quién se incentiva? / Quality of the prescription in Primary Care: who is incentivated?

Objetivo. Determinar factores extrínsecos (dependientes de la población atendida y de la organizaciónen la atención sanitaria) e intrínsecos (dependientes del profesional) que se asocian a la calidad de la prescripción y a la percepción de incentivos en los facultativos de equipos de Atención Primaria (AP).Material y método. Estudio descriptivo realizado en el Área Sanitaria de Albacete. A lo largo de 2005 y a través del Programa Digitalis, se obtuvieron los datos de los indicadores de calidad ligados a la incentivación de los 232 médicos que trabajan en las 34 Zonas de Salud del Área. Las variables estudiadas fueron: características del médico (edad, sexo, situación laboral, formación postgrado, asistencia a actividades de formación y colaboración en actividades docentespostgrado) de la población (proporción de ancianos/pensionistas y medio rural/urbano)y del puesto de trabajo (trabajo aislado, cambio en el puesto de trabajo, utilización del sistemainformático de prescripción).Resultados. El 61,6% de los médicos percibió incentivos ligados a la calidad de la prescripción en el año 2005. Se observó que la proporción de médicos que los percibieron fue signifi cativamentesuperior (p<0,05) entre los que trabajan en equipo o en consultas informatizadas, colaboran en docencia postgrado, participan en actividades de formación continuada y permanecen durante todo el periodo estudiado en el puesto de trabajo. La percepción de incentivos es más frecuente en los médicos que colaboran en actividades docentes postgrado (OR= 4,7), trabajan con carácter interino (OR= 3,1) y no cambian de puesto de trabajo a lo largo del periodo considerado(OR= 3,8).Conclusiones. Los resultados permiten identifi car factores condicionantes de la calidad de laprescripción, ligados a la percepción de incentivos, como son la situación laboral, las responsabilidadesdocentes y la participación en actividades de formación continuada

Objective. To determinate extrinsic factors (that depend of the assisted population and health services organization) and intrinsic factors (that depend of the professional) associated to the quality of the prescription and to the perception of incentives by physicians at primary care level.Methods. Descriptive study carried out in the Sanitary Area of Albacete. Along 2005 and throughthe Program Digitalis have been obtained dates about quality indicators in relation with incentivesperceived by 232 doctors who work in their 34 health zones. The studied variables were: characteristics of doctors (age, sex, labour role, postgraduate training, training programs followed, cooperation in postgraduate teaching activities), of the population (old people’s proportion and rural or urban people’s proportion) and work profi le (isolated placement, changes in the role, use of computerized system to assist prescription).Results. 61.6 % doctors perceived incentives in relation with the quality of the prescription in 2005. It has been observed that percentage of receptors was higher (p<0.05) among those that work in team or in computerized consultations, have an active cooperation in postgraduate teaching, are usual partnerships in continue teaching activities and have a stability in work. The perception of incentives is more frequent in doctors who collaborate in teaching postgraduate activities (OR=4.7), are temporary holders of a place (OR= 3.1) and don’t change place duringthe studied period (OR=3.8).Conclusion. The results make possible to identify three factors involved in quality’s prescriptionin relation with incentives perception: labour role, teaching responsibilities and collaboration withcontinuous teaching activities